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Focus on Obamacare Delays Mental Health Law
By Kyle Cheney�� Politico�� January 15, 2013

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Mental health advocates say a landmark 2008 law meant to expand access to millions of Americans has gotten back-burner treatment by the Obama administration because of its relentless focus on the Affordable Care Act.

As a result, key details are missing from the Mental Health Parity and Addiction Equity Act, awaiting a final rule from the administration that supporters say is “imminent.”

“It’s been our understanding that they’ve just been so bogged down with ACA rules coming out that it’s been delayed,” said Sarah Steverman, director of state policy for Mental Health America, in a phone interview just minutes before the Department of Health and Human Services issued a 474-page rule on President Barack Obama’s health law.

It’s an issue that could get new attention when Vice President Joe Biden’s gun violence task force releases its recommendations Tuesday, since some prominent Democrats are urging the administration not to overlook the importance of mental health care – and to finish putting the 2008 law into place.

In the aftermath of the Newtown, Conn., massacre, a renewed focus on mental health services has put the unfinished law back in the spotlight. Democratic Sens. Al Franken of Minnesota and Tom Harkin of Iowa appealed to Biden last week to include final guidance on the mental health law among recommendations to respond to the shooting that left 20 schoolchildren dead.

“[W]hile this historic law was passed four years ago, the administration has yet to issue a final rule, potentially leaving many Americans who need and have a right to these services without access to them,” the senators wrote.

Some Republicans are wondering what’s up with the rule, too – and not in an idly curious way.

“I’ve yet to hear a convincing explanation as to why three years have passed and yet we’re still waiting on a final rule for mental health parity,” Rep. Tim Murphy (R-Pa.), the chairman of the Oversight and Investigations subcommittee, said in a statement to POLITICO. “If this can’t be resolved in short order, Congress is duty bound to take assertive action.”

Andrew Sperling, director of federal legislative advocacy for the National Alliance on Mental Illness, said the ACA rule making “took precedence” over the mental health law, partly by necessity.

“There were so many different regulations on the ACA essential health benefits, insurance market reforms, employee wellness programs,” he said. “It’s the same people writing the same regulations. Given the timetables they’re under, the time constraints they’re under to get the ACA regs out, that took precedence.”

Most of the law is in effect, requiring group health insurance plans and other insurance policy issuers to treat mental health services essentially the same as they treat medical and surgical benefits – in other words, comparable co-pays, treatment limits and benefits. Deductibles for mental and physical services must also be linked to reduce out-of-pocket expenses.

But what’s missing from the law, as it stands today, is guidance on how insurers must treat “nonquantitative” treatments – policies meant to contain health care costs, such as determinations of medical necessity, standards for providers to be included in a health plan’s network and restrictions on expensive forms of therapy or rehabilitation.

“These services we know are to get people back to their lives,” Steverman said. “The question is, what actual services are included in those?”

In addition, a final rule would lay out the “scope of services” covered under the parity law. “Getting a final rule would be critically important,” Sperling said. The rule is important, he said, “where we still see gaps in parity, where we still see uneven coverage in mental health and addiction services on one hand and medical/surgical on the other.”

An interim final rule, lacking those details, was issued in February 2010, a month before Obama signed the ACA into law. An HHS official told POLITICO the final rule for the mental health parity law is “going through the normal process” and that there is no “update on timing,” despite confidence among advocates that the final rule is imminent.

Advocates are quick to praise the ACA for its own mental health provisions – requiring some free preventive mental health services and including mental health benefits among services required to meet minimum coverage standards.

Insurers supported the passage of the mental health parity law but have raised a variety of concerns about the interim rules in place, most prominently, confusion about how health plans are supposed to compare restrictions on “nonquantitative” health services like therapy to restrictions on physical and surgical care. In testimony submitted to HHS in response to the interim rule, America’s Health Insurance Plans worried about making the tricky comparison, especially within plans that have separate vendors for mental and physical health.

Mental health advocates met with Biden’s gun violence task force – which included HHS Secretary Kathleen Sebelius and Attorney General Eric Holder – last Wednesday.

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